BioIdentical Hormones
For Anxiety and Depression 

by Dr  Jeffrey Dach MD

56 year old Susan suffered from anxiety and panic attacks, and had been prescribed  Valium, Effexor and Wellbutrin by her primary care doctor.  The drugs had adverse side effects and didn't seem to be helping, so she stopped taking them.  After further discussion, she  told me that symptoms started a few years ago when her monthly cycles stopped and with the onset of menopausal hot flashes.  She noticed that the anxiety and panic attack seems to precede an episode of hot flashes.

Left Image: Anxiety, Fear and Panic courtesy of Wikimedia commons

Estrogen Deficiency Causes Anxiety

We sent Susan to the lab for a hormone panel, and sure enough, Susan's estrogen level was low. Susan's symptoms were caused by menopausal estrogen deficiency, a finding commonly seen in the post menopausal age group. Symptoms are promptly relieved with bioidentical estradiol applied as a topical cream twice a day.  Additionally, Susan's tests revealed vitamin and mineral deficiencies which were, no doubt, aggravating the anxiety attacks.

Susan was started on her bioidentical hormone program which included estradiol and progesterone as a balanced topical cream. She was also started on vitamin B12 and Magnesium supplements.  Six weeks later, Susan reported that her anxiety and panic attacks had improved and were almost gone.  She also noticed better sleep and more clarity of mind, and her night sweats and hot flashes had resolved as well.

Anxiety is Associated with Hot Flashes

A study published in 2005 Menopause reported that anxiety is strongly associated with menopausal hot flashes, and usually precedes the hot flash episode. (13)  Hot flashes are caused by estrogen deficiency, and are treated with bioidentical estradiol, which virtually eliminates them.(15)(16)(17)

above image: dont panic courtesy of wikimedia commons

The Benefits of Bioidentical Estrogen

My previous articles discuss the safety and the importance of bioidentical hormones.

Uzzi Reiss's new book Natural SuperWoman contains an excellent discussion of bioidentical hormones.  Chapter 4 covers anxiety, panic attacks and relief with bioidentical estrogen.(1)  Numerous articles (see below) summarize the medical literature showing that low estrogen levels cause anxiety and depression in humans and animals.  Estrogen treatment relieves anxiety and depression as well as virtually eliminates the hot flashes.



What is the Mechanism of Action Of Estrogen in Eliminating Anxiety and Depression?

Estrogen receptors have been found in the brain, and estrogen increases the expression of an enzyme in the brain called tryptophan hydroxylase-2 (TPH2).  This enzyme converts tryptophan to serotonin, an important neurotransmitter responsible for an anti-anxiety and calming effect in the brain.  These estrogen receptors have been isolated to specific areas of the brain call the DRN, or the dorsal raphe nuclei (2)(3)(4)(5)(6).

Estrogen Effective for Perimenopausal Depression

A study published in the 2001 Archives of General Psychiatry evaluated bioidentical estrogen as treatment for peri-menopausal depression.  They evaluated fifty women ages 40-55 years, suffering from a depressive disorder and irregular menstrual periods (FSH >25 IU/L).  These women were treated with bioidentical estrogen or placebo over 12-weeks.  Remission of depression was observed in 17 (68%) women treated with bioidentical estradiol compared with only 5 (20%) in the placebo group.  The authors concluded,  "Transdermal estradiol is an effective treatment of depression for perimenopausal women."(7)

Above left image: Brain Anatomy of DRN: The formatio reticularis of the medulla oblongata, shown by a transverse section passing through the middle of the olive of the midbrain showing (4) DRN Dorsal Raphe Nucleus courtesy of wikimedia commons  4. Raphe.

Estrogen Effective for Post-Partum Depression (after child birth)

Postpartum depression is seen in approximately 13% of women who have recently given birth, and often remains untreated. (10) Various treatments have been tried, including antidepressant drug therapy (SSRI's), bioidentical estrogen, individual psychotherapy, and group psychotherapy. (10)

A study published in the 2001 Journal of Clinical Psychiatry showed that bioidentical estrogen is effective for post-partum depression.(8) Twenty-three women suffering from postpartum depression were recruited from a psychiatric emergency unit.  The women were treated over 8 weeks with bioidentical estradiol (sublingual form).  Baseline serum estradiol levels were very low with a mean of 80 pmol/L, or even lower suggesting ovarian failure. During the first week of estradiol treatment, depressive symptoms resolved rapidly, and serum estradiol levels increased to 340 pmol/L.  By the  second week of treatment, 83% of patients showed clinical recovery.

Left image: Harold Gilman (1876 - 1919). Mother and Child, 1918, oil on canvas. Auckland Art Gallery, courtesy of Wikimedia Commons.

A second earlier study published in 1996 Lancet showed that bioidentical estrogen is an effective treatment for post-partum depression.  Sixty One women suffering from post partum depression were given transdermal estradiol (0.2 mg daily), and rapid improvement was reported during the first month of treatment.(9)

Many women with post-partum depression are treated with SSRI antidepressants which does not address the underlying estrogen deficiency and ovarian failure.  In my opinion,  bioidentical hormone treatment is a more effective and safer treatment alternative.    Bioidentical estrogen has none of the adverse effects associated with SSRI antidepressants which, after all,  may end up in mother's milk, and may have adverse effects on the breast feeding baby.

Estradiol for Post Partum Psychosis

While post partum estrogen deficiency causes depression in 13%  of patients, a smaller subset go on to develop full blown post partum psychosis. Bioidentical estrogen is also effective for this more severely effected group.  A study done in Finland published in the 2001 Journal of Clinical Psychiatry evaluated 10 women suffering from post partum psychosis.  All had low serum estradiol (mean of 50 pg/ml) indicating gonadal failure.  All were treated with bioidentical estradiol, with serum estradiol levels rising to normal.  Remarkably, estradiol treatment reversed psychiatric symptoms in all patients. (11)

Estradiol  Improves Cognition for Alzheimer's Dementia

In a study published in 2001 Neurology, twenty postmenopausal women with Alzheimer's dementia were treated with bioidentical estradiol (0.10 mg per day, topical) and compared to placebo.  Sophisticated neuropsychological tests showed improvement in attention, and in verbal, visual and semantic memory compared with subjects who received a placebo.(12)

Estradiol Reduces Anxiety in Mouse Model

Alicia A. Walf examined a mouse model in which Estradiol reduces anxiety- and depression-like behavior of aged female mice. Her findings were justpublished in   Neuroscience Research in Feb 2010.  Matthew N. Hill investigated the mechanism of estradiol as an anxiolytic, and he implicated the enzyme, fatty acid amide hydrolase (FAAH), which  degrades the endocannabinoid anandamide.  FAAH is regulated by estrogen.  Obviously, this is a fertile area for new research, as the exact mechanism has not yet been elucidated.

Left image : lab mice courtesy of wikimedia commons

Links to Associated Content:

The Importance of Bioidentical Hormones

The Safety Of Bio-Identical Hormones by Jeffrey Dach MD

The Battle for BioIdentical Hormones by Jeffrey Dach MD

Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD


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